Tag Archives: relationships

Helping clients with post-date anxiety

By Kathleen Smith October 15, 2018

As a counselor, I have a front-row seat for watching anxiety develop in new relationships. It is truly fascinating to observe how quickly two people can become emotionally stuck together. A therapy client will leave for a week and return reporting that he or she has started dating someone new. This former stranger now has the power to make my client very happy or very anxious. Thanks to their phone, my client might spend all day analyzing a text they received — or worrying about the lack of one.

Not a week goes by without me having multiple conversations with people about texting in relationships. For instance, a person is seeing someone who doesn’t quite contact them as frequently as they would like, so their brain sounds the rejection alarm. When the other person finally does text them, their anxiety level goes down. But within a day or two, they need more reassurance. They’ve surrendered their capacity to calm down to someone who was a stranger to them a week ago. And the only way they know how to get that capacity back is to end the relationship.

I don’t think that texting causes emotional dependence, but it can certainly accelerate it and reinforce it. People used to have to wait much longer to hear from a prospective romantic partner. Now people want to hit the eject button if there’s been radio silence for 24 hours. There is an expectation that someone who is interested in us must also be available to us at all times. We are in such a hurry to lock things down as a way of managing our own anxiety and insecurity.

I’m in no position to throw a stone here. After my husband and I went on our first date, he waited five days to ask me out again. Five. Days. For millennials, five days is the equivalent of somebody going off to war and coming back home. Now, of course, I know that he was a mature human being who was simply living his life at that time. But if you retrieved my phone records from that week, I bet you would see a blizzard of worried texts to friends.

When our counseling clients become more anxious in a new relationship, they don’t suddenly become more insightful. They usually just double down on whatever they’ve already been doing. That usually means anxiously focusing even more on this new person. They might stalk them on social media, or stare at their phone trying to decipher old texts. They’ll talk to all their friends about whether they should dump this person for taking so long to reply. They’ll come to a counseling session and ask me to guess what this person — whom I have never met coincidentally — is thinking.

When we feel the potential to be hurt, it makes sense that we focus more on the threat and how to avoid it. This works great if a lion is chasing us. It’s not so great for being in a relationship.

People see a lot of lions when they date, simply because dating is such an anxious endeavor. They interpret a lack of constant contact in a new partner as a sign of flakiness, disinterest or duplicity. People don’t stop to consider whether less contact might be a potential sign of maturity. This is why people tend to end up with other people who are at the same level of emotional maturity as themselves. People who have a higher degree of maturity in their family relationships are likely to seek out a partner who wants the same amount of contact.

I would never say to a someone, “Have you considered that this person is not texting you as much because they’re more mature?” Because that would be a guess based on zero facts. What I do challenge people to do, however, is to see their part in the relationship. Often, if people can stay focused on being the person they want to be rather than on trying to control this new love interest of theirs, then their anxiety will go down. And most of the time, people do not want to be the kind of person who is glued to their phone 24/7.

So, the goal isn’t for clients to change their new crush or to teach the person how to text that Goldilocks (just right) amount. The goal is to lower clients’ anxiety enough to where they can actually think objectively and decide whether a relationship is right. That decision is impossible to make when anxiety is very high, because then we interpret even the smallest behavior as a threat. People will blow up a relationship quickly in order to lower their anxiety.

Anxiety isn’t just present in romantic relationships, of course. We all want people to like us, reassure us and agree with us, but we ultimately can’t control them. People in our lives are not always going to respond as quickly as we would like. They’re not always going to RSVP to the party or share our level of enthusiasm for a television show. If clients can see how the anxiety they feel is a possible sign of emotional interdependence, they might be less likely to act immaturely or irrationally in their relationships. The rejections or silences won’t feel so threatening, and they won’t have to cancel that party out of spite or send a passive-aggressive message.

The simple truth is that we enjoy relationships more when we aren’t as anxiously focused on them. By being more of an individual, we can actually get closer to the people we love. Who doesn’t want that?

 

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Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Read more of her writing at kathleensmith.net.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

The lingering influence of attachment

By Laurie Meyers June 25, 2018

A few years ago, American Counseling Association member Lisa Bennett took a trip to Southeast Asia. While there, she thought it would be fun to visit an elephant sanctuary where sick and injured animals had been sent to heal. What she saw fascinated her. The elephants engaged in attachment behavior.

Among herds, young elephants are raised not just by their mothers but by an older female who has already had babies and “retired,” moving on to another tribe. These older females return to their original herd, however, to serve as nannies to the young elephants. Bennett noticed that the nanny elephants seemed to be teaching the mother elephants how to connect with their calves.

“Nannies will literally push the mother toward the calf when the calf is in need and will model to the mother the actions to take to secure the calf’s safety and security,” Bennett says. The calves still viewed the mothers as their primary attachment figures but also displayed an attachment to the nanny elephants.

Of course, as a professor and director of clinical mental health counseling at Gonzaga University in Washington state, Bennett knows that attachment theory has even bigger ramifications for counselors and the clients they serve. All humans are born with the need for engagement with and responsiveness from other humans, says Bennett, who studies and gives presentations on attachment theory. People need to be touched, to be stimulated, to feel safe and to believe that someone — usually their primary caregiver or caregivers — will provide things for them. In other words, people need to be “attached.” If children don’t feel as if they have reliable attachment figures — a source for stability and safety — they are more likely to experience anxiety and have difficulties trusting others and forming relationships, Bennett says.

Bennett recently took a group of students from various programs, including clinical mental health, marriage and family therapy, and school counseling, to a wildlife park containing elephants. She wanted them to observe attachment in action in the animal kingdom and apply what they saw to human behavior.

Interestingly, Bennett’s group also observed that elephants can transfer their attachments to humans. In the park, there was no way for retired females to return to their old herds. As a result, there were no elephant nanny figures. However, whenever the human trainer appeared, the calves responded to him as if he were a nanny. Bennett believes that because human attachment is analogous to that of other animals, the elephants’ consistent attachment to a nanny figure showed that secondary attachment figures play an essential role in well-being.

Attachment theory is derived from the combined work of John Bowlby, a British child psychologist and psychiatrist, and Mary Ainsworth, a Canadian psychologist. The theory posits that infants have an instinctual survival-based need to form an emotional bond with a primary caregiver. This attachment provides a sense of safety and security. If children receive consistent attention and support from a caregiver, they are more likely to develop a “secure” attachment style. Children who do not receive consistent attention and support develop insecure — avoidant or anxious — attachment styles. Attachment style affects a person’s sense of self and shapes his or her ability to regulate emotions and form relationships.

Bennett notes that neurological research shows that humans are wired to make attachments, but these connections need to be reinforced, optimally between birth and age 2. However, children can become attached at an older age if they receive the right care and connection, she says. In addition, if a primary caregiver does not cultivate attachment in a child, another caregiver can provide that crucial link by responding to the child’s emotional and physical needs with “connection and delight,” Bennett says.

As children develop, they form a working model of the world and themselves, Bennett says. Children who have secure attachments tend to believe that they are lovable and likable and that other people are safe and kind and will meet their needs, she explains. Children whose needs are not being met generally develop one of two beliefs about themselves and the world. Those who have formed an avoidant style of attachment often believe that they are OK but that the world and the people in it are bad. Children who have developed an anxious style of attachment usually think that other people are generally benign but that they themselves are bad or unlovable, Bennett explains.

ACA member Joel Lane previously worked with children, adolescents and young adults and now supervises counseling trainees who work with this same population. He says that attachment issues often play a significant role in clients’ presenting concerns, either as the primary difficulty or as a complicating factor. With children and adolescents, much of Lane’s work consisted of helping these clients and their parents or caregivers understand one another’s needs better.

Attachment styles — and the interpersonal behaviors they engender — can form a lifelong emotional template. People with secure attachments know they can depend on those to whom they are attached to be available for support and vice versa, says Christina Schnyders, an assistant professor of counseling and human development at Malone University in Ohio and a frequent researcher and presenter on attachment issues. In contrast, anxious attachment creates fear that an attachment figure will not be dependable, she explains. In response to this fear, people with the anxious attachment style can become co-dependent and may also become frustrated or angry because their relational needs are not being met. People with avoidant attachment create distance from others to prevent having to depend on anyone or having anyone depend on them.

Each of these attachment behaviors affects how people function in crucial life areas such as family, peer and romantic relationships, Schnyders says. Attachment style can even influence a person’s career choice and interactions in the workplace.

Leaving the nest

Lane, an assistant professor in the counselor educator department and coordinator of the clinical mental health counseling program at Portland State University, studies attachment, particularly as it relates to the population known as “emerging adults” (those in their late teens to late 20s). Emerging adulthood is a time of tremendous interpersonal transition that usually involves an individual leaving the parental household, forming new friendship groups and getting more attachment needs met by peers — and particularly by romantic partners — rather than by family members or caregivers, he says.

Transferring attachment needs from parents or caregivers to peers is a process that typically begins in a person’s teens, says Schnyders, an ACA member and part-time college counselor at Malone. Parental attachment doesn’t become any less vital at this time; it’s just that peers are placed higher on the attachment hierarchy, she explains. In fact, having a secure attachment to parents or caregivers is critical to adolescents’ ability to make connections with their peers, says Schnyders, a licensed professional clinical counselor formerly in private practice.

“Attachment beliefs inform our sense of self and others, particularly during times of distress,” Lane says. For example, in stressful situations, people with attachment insecurity may believe they are incapable of dealing with the problem, he says. Stress may push those with anxious attachment to rely solely on other people rather than deploying their own problem-solving skills, whereas people with avoidant attachment may believe they cannot count on others to provide emotional support, causing them to withdraw from the support system and creating greater isolation, Lane explains.

In contrast, emerging adults who have formed secure attachments to peers and parents are more resilient and better able to handle changes, both good and bad, Schnyders says.

“Put simply,” Lane says, “attachment plays a major role in understanding our emotional needs and getting those needs met. And in emerging adulthood, it can be especially important since our emotional needs evolve, as do the groups of people whom we hope or expect to meet those needs.”

The question becomes, how can counselors help “fix” an attachment style that may be having a negative impact on multiple aspects of a client’s life?

Lane doesn’t believe it’s a matter of changing clients’ attachment styles. Rather, he says, counselors can help clients better understand and anticipate their attachment needs, which can lead to increased attachment security over time.

“I believe that the counseling relationship provides clients with corrective attachment experiences,” he says. “When we feel heard, seen and understood, insecure attachment beliefs are challenged, and secure attachment beliefs are reinforced. Over time, this can have a powerful impact on how we view ourselves and how we view others. We can also help our clients learn to better understand their attachment needs and communicate those needs to others.”

Schnyders uses psychoeducation to teach clients the differences between secure and insecure attachment. She then uses cognitive behavior therapy to help clients understand how their insecure attachment has created core, irrational beliefs. Schnyders and the client then work together to reframe and restructure these beliefs. This allows clients to acknowledge and address the insecurities and fears that drive their behavior, better enabling them to modify their personal interactions.

Schnyders says that narrative therapy can also be useful, particularly with emerging adults. She guides clients as they create a narrative riddled with problems connected to their attachment style. Once that narrative is constructed, Schnyders and the client work to create an alternative storyline that focuses on elements of secure attachment and talk about how to work toward that story.

Attachment and romantic relationships

“Attachment drives the way we experience ourselves and our significant others,” Bennett says. “It provides a lens for how we see and interpret them.”

There is no consensus on whether attachment styles influence the selection of people’s romantic partners, says Bennett, who works with couples in her private practice. At the same time, she can’t help but noticing the number of anxious and avoidant pairings in her office.

“Put simply, one keeps pushing or nagging at the other to be present, and the other is a great escape artist,” Bennett says. “Both [are] driven by their styles and both [are] really chasing the other off, even though that is not what either one wants.” The doubts and fears that drive such behavior are barriers to real intimacy, she adds.

To help couples identify and break the patterns that are sowing discord, Bennett teaches them about attachment theory and how their individual styles can affect the relationship. She then helps couples develop secure attachment behavior by teaching them how to be more available, accessible and responsive to each other.

Bennett says she often finds that couples don’t know what a nonsexual warm connection looks like, so she teaches them how to greet, touch and talk in nonsexualized ways that express love and care. Vulnerability is also a big issue. Couples need to be willing to be vulnerable with their partners and, conversely, to react gently, she says.

Bennett also frequently works with couples on how to change their “demands” to “requests” and how to respond to each other’s requests with warmth. In addition, relationship partners often need to learn how to apologize to each other, how to talk about their fears and anxieties with each other, how to listen to each other and how to turn to each other for support, Bennett says. Finally, she advises couples to get in the habit of immediately repairing any relationship “ruptures” rather than allowing them to fester and build.

People with attachment issues often have difficulty expressing themselves, which can lead to frustration and misunderstanding. Partly for that reason, Schnyders does a good deal of assertiveness training with couples to improve their communication. Learning to be assertive allows clients to communicate their needs without discounting the feelings of their partners.

When teaching assertive communication, Schnyders instructs clients to use “I” statements such as I want this. I believe this. I need this. In the process, she strives to change the way clients see themselves.

Schnyders tells the story of a 60-something female client with a pattern of insecure attachment. Schnyders had been focusing on self-esteem with the client, encouraging her to believe that she was a person of value and worth. The client was also having problems communicating with her husband, who had a habit of speaking at her rather than to her and treating her dismissively.

One day, the client came in and told Schnyders about a breakthrough. A recent encounter with her husband had devolved, as it usually did, to him speaking disrespectfully to her. All of the sudden, the woman found herself exclaiming to her husband, “You can’t speak to me like that. I am a person with value and worth!”

Her declaration stopped the husband in his tracks and, soon thereafter, their relationship dynamic began to change. With the client standing up for herself and beginning to believe that she was worthy of respect, Schnyders asked her to consider what she needed from her husband. The woman said she wanted to be able to hear and understand his needs without diminishing her own. Schnyders and the client then talked about how she and her husband could work together rather than following their previous pattern, which involved the woman placating him rather than standing up for herself.

Sometimes, just slowing down an interaction can improve communication. In couples and family therapy, rather than letting clients have rapid back-and-forth exchanges, Schnyders will slow the conversation and have participants tell their partners or family members what they need from them. Schnyders will then ask the partners or family members to repeat what they have heard because sometimes conflict arises from an inability to listen to what someone else is saying.

Attaching to a career

Like all areas of life that involve interacting with others, work can sometimes be tricky for those with insecure attachments. As Schnyders explains, if a person doesn’t trust their co-workers and can’t communicate and interact with them effectively, that person’s performance is going to be hampered, perhaps even putting them at risk of losing their job.

But attachment style can also play a role in the job search itself, says Stephen Wright, a professor of applied psychology and counselor education at the University of Northern Colorado. Wright, an ACA member, studies how attachment style affects career choice and decision-making in college students.

When it comes to considering careers, people who are securely attached have an advantage because they are less likely to perceive career barriers, according to Wright. In other words, they have more confidence in their innate strengths and their ability to cope with challenges. Those with secure attachment also are more likely to have a stable support system of people who bolster their confidence and may even have contacts that will assist in the career search, Schnyders says.

In contrast, those with insecure attachment are more likely to perceive many reasons that they will not succeed in a particular career field or in the career search itself, Wright says. These individuals are also less likely to have a support system in place.

That’s one area where professional counselors can come in. Counselors not only serve as a secure base for clients but can also boost their feelings of self-efficacy in various areas, which can diminish the effects of insecure attachment, Wright says.

By providing a strong sense of support, counselors may help insecurely attached clients perceive fewer barriers. Setting and completing specific goals — even small ones, such as researching a new profession — can help strengthen these clients’ sense of accomplishment and confidence, Wright says. If clients have shown interest in a particular career area, helping them learn more about it and explore the various jobs available in the profession can increase their sense of self-efficacy in that area, he says. If clients lack the required skills for a specific job, counselors can assist them in developing a plan to acquire those skills rather than let them perceive their current situation as an insurmountable barrier, Wright says. He also suggests that counselors use career models to assist these clients with decision-making and identifying their job-related strengths and weaknesses.

Recovering from child sexual abuse

Research indicates that people with secure attachment style find it easier to recover from child sexual abuse, says Kristina Nelson, an assistant professor in the Department of Counseling and Educational Psychology at Texas A&M-Corpus Christi who studies and works with survivors of child sexual abuse. Having secure attachment provides these individuals with a safe base from which to explore and process their experiences, leaving them better able to regulate their emotions, she says. The feeling of security from healthy attachment serves as a form of support in and of itself, adds Nelson, who was previously a private practitioner in Florida.

Survivors with insecure attachment styles have typically received inconsistent or limited support throughout their lives, and this leaves them feeling unsure of whom to trust, Nelson says. In addition, they often don’t know how to regulate their emotions or how to begin the process of recovery.

Counselors can offer the support that those with insecure attachment styles have lacked throughout their lives, Nelson says. “Counselors can actually serve as a secure base for a client. [They can] be that consistent presence by providing that constant positive regard, allowing them to explore and make sense of their experiences.”

Counselors can also help these clients learn how to regulate their emotions. Nelson often recommends deep breathing techniques to her clients and adds that some people find meditation helpful. She cautions, however, that because meditation involves closing one’s eyes in a dark room, it may be a trigger for sexual abuse survivors, so counselors should proceed carefully.

Psychoeducation about attachment styles can also help clients gain awareness about why they react the way they do and how they developed their coping mechanisms, Nelson says.

Permanently attached?

So, is everyone stuck with their childhood attachment styles for life? Not necessarily, say Bennett and Lane. Although attachment style is usually pretty stable, there are cases in which it can change.

“The idea here is that we have core perspectives that tend to drive core styles,” Bennett says. “I’d venture that friendships and workplace relationships can have an impact, but our primary home styles are more likely to set the tone.”

“If impacted by social and work settings, we can repair by going home, by changing up friendships, by moving jobs,” she continues. “If stuck in an unhealthy work environment or social setting without recourse or the capacity to go home and mend, it makes sense that we’d alter to a less secure base, sadly.”

This is also true in relationships, Bennett says. For example, if a spouse repeatedly behaves in ways that erode the person’s trust in the spouse or in themselves, then that person’s attachment style can warp into a less secure one, she says.

Lane says there is some evidence that insecure attachments can become more secure throughout adulthood. He believes this may happen as people shift their attachment needs to people of their own choosing rather than the families they were born into or the caretakers they were placed with.

“I think that important interpersonal experiences influence and are influenced by one another,” he says. “When we regularly experience our needs being met as infants, we are more likely to be able to form healthy interpersonal relationships throughout life. However, adverse life and interpersonal experiences can still disrupt our attachment system, especially after multiple significant adverse experiences. The reverse also seems to be true — insecure attachments in childhood decrease the likelihood of healthy attachment relationships later in life. However, when those healthy relationships occur, they can influence our attachment orientations toward being more secure.”

 

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Related reading

To learn more about issues related to attachment, read the following articles previously published in Counseling Today and available on the CT Online website at ct.counseling.org:

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Guiding lights

By Bethany Bray May 30, 2018

Counselor supervision is a rite of passage for professional counselors. Although supervision requirements vary from state to state, the crux of the experience — learning that is based in a relationship between a beginning counselor and an experienced practitioner — is universal. As is the case for any relationship to remain healthy and beneficial, the supervisor–supervisee pairing requires care, hard work, respect and trust from both parties.

Supervision is meant to be “the other half” of counselor education, bridging classroom learning and in-session counseling skills, says Summer Reiner, a licensed mental health counselor (LMHC), clinical supervisor and associate professor and school counseling coordinator at the College of Brockport, State University of New York. “There’s no way you can fully prepare the student in a classroom. Supervision is to fill out your education,” says Reiner, president of the Association for Counselor Education and Supervision, a division of the American Counseling Association.

Supervision begins “a lifelong process of always stepping back and looking at what went well and what didn’t,” she adds. “Supervision is training to be able to do that throughout your career, a constant of thinking what went well and what do I need to do differently? It’s a supervisor’s role to get that internal dialogue moving, by demonstrating it first and letting [supervisees] know that they will self-evaluate, in a healthy way, throughout their career.”

Balancing act

The supervisor–supervisee relationship is different from the therapeutic bond forged between counselor and client. However, many counseling skills come into play as supervisors support and foster growth in their supervisees. Although supervisors never shed their identity as counselors, they must learn to shift gears between working with clients and working with counselors-in-training or beginning professionals.

Supervisors must also achieve a balance between two primary roles that can, at times, feel like they are at odds with each other: fostering an open and honest dynamic with supervisees and evaluating supervisees. The best learning opportunities often arise when supervisees feel comfortable with and have enough trust in their supervisors to ask questions and admit when they are struggling.

“It’s a delicate balance,” says Kevin Doyle, a licensed professional counselor (LPC), clinical supervisor and adjunct instructor of counselor education at Virginia Tech. “The supervisor has the power, but it still needs to be an open relationship. … A supervisor should focus on creating a connection that is similar to counseling, with focus on the supervisee’s professional growth and development. Transparency is paramount, even though there’s a grade or evaluation piece to the situation.”

“It’s one of the biggest fissures in supervision: There’s this evaluative piece. It’s similar to a counseling relationship, but you also have the responsibility to assign grades or to be a reference for a future employer,” says Doyle, a member of ACA. “It’s not a counselor–client relationship, but it also shouldn’t be an inverted relationship” with a power imbalance.

Supervisors are a unique blend of teacher, counselor, evaluator and role model, and they need to be able to nimbly weave in and out of those roles as the moment demands, Reiner says. Throughout the process, counselor supervisors should remain very supportive of their supervisees while also offering honest feedback.

“Help them understand that we’re not evaluating them as a person, or as a counselor, but with each intervention they use with a client,” says Reiner, whose experience is with graduate student supervision as a counselor educator. “This isn’t me judging you; it’s me helping you see what was your intent in this process? What was the intended outcome? If that didn’t happen, what would you have changed?’”

“At the same time,” she continues, “it’s important not to be a cheerleader. Don’t let them feel like everything’s OK when it’s not. It’s this balancing act of having students hear critical feedback without personalizing it and [then] using it constructively.”

Stacey Brown, an LMHC and clinical supervisor in Fort Myers, Florida, stresses that the best supervision happens when the relationship is central to the experience, which transcends simply going through the motions of clocking the needed hours and ticking items off of a to-do list. “For me, it’s about becoming a counselor — beyond the techniques they learn in grad school,” says Brown, an ACA member. “It’s very easy to forget the human part of the equation, and our role as nurturer and encourager, as there are so many boxes to tick. Don’t make it so structured that [supervision] sessions are repetitive or predictable. Be open and allow flow to happen, like you would in a counseling session. You can still cover everything you need to cover, but be creative and open to what comes. Otherwise, you may lose out on [teaching] opportunities that pop up.”

For example, a supervisor might have a stack of case studies ready for review with a supervisee, but the beginning counselor walks into the room with tears in her eyes because of professional stress or something going on in her personal life. In that case, “You shouldn’t push forward with your case reviews,” Brown says. “You should take a step back, ask what’s going on and how can you [the supervisee] manage it? But if I have some kind of checklist to get through, I will miss out on opportunities to help her become a counselor. Teach [supervisees] flexibility, intuition, being present and learning that they have to deal with their own stuff and take care of themselves to be able to help other people. What better way to teach that than by doing it?”

Modeling and forging a bond

Doyle says the skills that supervisees gain through counselor supervision can be divided into two realms: everything that happens in the room with clients, and everything that happens outside of the counseling room.

The first part of the equation, the “nuts and bolts” of counseling, as Doyle calls it, is developed through case review and the one-on-one guidance that a supervisor provides. It involves real-time application of the knowledge base that counseling students were introduced to in graduate school.

The second part encompasses learning that can’t truly be acquired from textbooks. It involves preparation for the entirety of the job of being a professional counselor, Doyle says. Much of the knowledge acquired in this sphere is based on how supervisors model their own professional skills, both inside and outside of client sessions, in the presence of their supervisees. Supervisees watch and absorb not only their supervisors’ interactions with clients, but also the professional boundaries that supervisors set, how much they focus on self-care and how they manage time, professional ethics and other aspects of the job.

Supervisees “absorb so much from how we carry ourselves and what we do in supervision,” says Doyle, who wrote his doctoral dissertation on how supervisors can model wellness and how that influences supervisees’ wellness.

A little self-disclosure, when appropriate, on the part of supervisors can help keep the supervisor–supervisee relationship open and honest, says Kathryn Henderson, an LPC and an assistant professor at the University of Saint Joseph in West Hartford, Connecticut. When supervisors disclose, for example, that they sometimes struggle to prioritize self-care, it demonstrates not only that even supervisors are imperfect but also that wellness will need to be a career-long goal.

“I stress that we’re in this together,” says Henderson, an ACA member. Supervisors share “our knowledge and experience, but we’re learning from [our supervisees] and growing ourselves. We’re learning just as much from them as they are from us. It’s mutually enriching.”

Brown says she is upfront with her supervisees that counselors are no different from the general population in that they sometimes have trauma in their past, struggle with an inner critic or anxiety, or face other challenges. “Part of being a good counselor is being comfortable with yourself and coming to terms with your own issues. I can’t be [my supervisees’] therapist, but as a supervisor, [I] can recommend they see a therapist,” Brown says. “I tell people right off the bat, there’s no reason to hide who you are.”

Brown also thinks that supervisor self-disclosure, within ethical boundaries, can strengthen the relationship with supervisees and help them realize that being honest about their struggles won’t sabotage their evaluation. Brown recalls one supervisee who had an infant at home. When Brown would check in with her about her stress level and self-care routine, the supervisee would insist she was fine. In truth, she was struggling with breastfeeding and a severe lack of sleep. The supervisee opened up only after being shown photos of Brown’s children and having Brown share a few of her own struggles during motherhood.

“My job, as I see it, is not to be rigid or pretentious at all, but to be real,” Brown says. “Being a real person who can share my experiences, my missteps, my learning, my boundary conflicts, my wellness efforts, etc., helps supervisees to be willing to be real with me. Then I
can see who they are and can offer suggestions that can help them personally and professionally.”

“The relationship is the most important part of the supervision,” she continues. “Elements of trust, mentoring, nurturing, directing, humor, compassion and tutoring are all there, just as in the counseling relationship. The difference is that in supervision, the supervisee will one day be completely equal or surpass me in credentials and expertise. I treat them as colleagues while still offering the nurturing and guidance and respect they need and deserve.”

Henderson agrees that trust is paramount in creating a good supervision experience. For supervisors, this includes trusting their supervisees enough to give them room to find their own way professionally. For supervisees, this means trusting the relationship enough to be able to share — and, in turn, work on — their weaknesses and areas of struggle.

“You can’t give someone insight; [a supervisee] needs to find that on their own. But we can create that opportunity in supervision,” says Henderson, co-editor with Alicia M. Homrich of Gatekeeping in the Mental Health Professions, published by ACA in May. “Supervision is their first time working with real clients in a real-world setting and applying what they’ve spent so many hours learning. That can be scary and overwhelming — there’s a fear of inadequacy. … The crux of supervision is that you’re not alone in that. This is exactly where you go to talk about those concerns and get the support and help that you need to grow in your own self-awareness and confidence in your skills.

“Supervisors are the ones to build that support [by offering] encouragement and validation. All of that helps create an environment where I [the supervisee] can come and bring my greatest concerns and failures, be vulnerable and not be afraid of being judged or of negative outcomes or consequences. Trust is so needed to create that environment.”

It takes two

What does it take to establish a healthy and beneficial supervision experience? In part, both parties must contribute by being flexible and practicing open and honest communication.

Suggestions for supervisees

Shop around to find the best fit. Look for a supervisor with whom you click, both professionally and personally. Alicia Simmons, a counselor intern working toward counselor licensure in Florida, found her supervisor, Stacey Brown (quoted in this article), by searching online and talking with friends from graduate school. She called and spoke with Brown before meeting her in person to test the waters of what would become a very positive supervision relationship. Simmons and Brown co-presented a session, “Intuitive Clinical Supervision: Creative Solutions for Helping New Counselors,” at the ACA 2018 Conference & Expo in Atlanta this past April.

“Look for someone who is going to walk beside you for … however long it takes,” says Simmons, a clinician and play therapist at an agency that serves children removed from their homes due to trauma or neglect. “Don’t be afraid to ask questions before you begin. You want to know you’re in the right fit. Don’t be afraid to try more than one supervisor. … Look for someone who is going to be flexible and work with you in the way you need to work. If you don’t know what that is, work with someone who will help you figure that out.”

Speak up. If you have a need that is not being met through the supervision experience, talk to your supervisor in a tactful but honest way. Doyle acknowledges that this can be a tall order because supervisors are seen as authority figures. At the same time, identifying any area where you might be struggling in the relationship will actually help your supervisor, he says. Counselors who provide supervision have so much to focus on — including client needs, scheduling, paperwork and so on — that they may not notice everything going on with their supervisees.

“Advocate for your needs [even though] that’s a lot to ask at the outset,” says Doyle, who will be starting a new job as assistant professor of mental health counseling at the University of Tennessee at Chattanooga this fall. “Speak up when you need support. Realize that the supervisor will rely on that. … When you come to see your supervisor as a safe person, you will really connect with them and [that will] make it easy to disclose your struggles.”

Respect the process. Keep in mind that your supervisor likely took on this extra responsibility because he or she wanted to “pay it forward” to the profession, Reiner says. Yes, supervisees have needs that should be met through the supervision experience, but at the same time, they must remember that a counselor’s first priority will always be client care.

“Step one is being appreciative that someone was willing to take you on as a supervisee and has trust in you that you will be able to serve clients well,” says Reiner, an ACA member. “Keep in mind that you are practicing under the license of someone else. If the [supervisee] does something really inappropriate, it can open the supervisor up to a lawsuit. They are taking on a personal risk as well as an additional workload. … Recognize that the supervisor is investing in the future of the profession and has no obligation to do that. Realize that they care about your future and the clients you are going to work with.”

Be authentic and drop preconceived expectations. Bring your true self into supervision. Don’t act one way with clients and another way with your supervisor. There should be “a thread of authenticity” throughout your work in supervision, Simmons says. “Counseling is basically holding up a mirror and showing somebody what’s there. Supervision I think ideally would be the same way.” Authenticity, both on the part of the supervisee and the supervisor, builds trust, she asserts.

In addition, it might be best for supervisees to leave behind their ideas of what supervision should look like. The important thing is for the supervisor and supervisee to be working toward the same goals. “What I had heard about clinical supervision was mostly [about] case review and going over the work with clients — very textbook and academic,” says Simmons, an ACA member. “What I’ve learned is that it can be much more fluid than that. All the in-between stuff is what has stuck with me and helped me develop my own style and confidence in my abilities. It’s about more than just the logistics of what’s going on in each [client] case.”

Remain open to feedback. Having a relationship built on trust makes it easier for supervisees to remember that any critical feedback they receive from their supervisor is meant to help them and that they are both working toward the same goal: the supervisee’s growth and development as a counselor. “It’s the same as the counseling relationship — you have to have that rapport,” Simmons says.

Regardless, being critiqued can prove challenging. “As a supervisee, it’s our responsibility to be able to receive feedback,” Simmons says. “If there’s something that’s getting in the way, perhaps that’s something [we] need to work through. We may need to seek therapy ourselves to work on it. Check yourself: Is it something related to the supervisor, or is it something unrelated that you need to work on?”

Think for yourself. At the same time, do not accept feedback blindly. Think it through and talk through any areas you have questions about with your supervisor, Reiner advises. But first, take a step back and consider whether you have received similar feedback from others in the past.

“Critically examine any feedback that you are receiving and be open to being the one who needs to grow and change. Or simply say ‘thank you for that feedback’ and ‘I’ll be mindful of that in the future,’” Reiner says. “I don’t think that supervisees know that supervisors are sometimes uncomfortable sharing critical feedback. They have probably thought it through [before telling supervisees] and were anxious about it themselves.”

Suggestions for supervisors

Temper criticism. Set realistic expectations and frame criticism in a way that lets supervisees know you’re focused on their growth, Doyle says.

In Reiner’s work supervising graduate students, she assures them that she won’t start evaluating them for a grade until halfway through the semester, once they have settled into the experience. It is important to stress that feedback is never personal but rather focused on supervisees’ development, Reiner says.

“There’s also an element of modeling for your supervisees — ‘This is how you have hard conversations with people.’ [They] will need to do that as a counselor,” Reiner says.

Debunk myths of perfection and the existence of one right way. Henderson shares an important lesson with her supervisees that she learned through her own supervision: There is no such thing as a perfect counseling session. Supervisees often put enormous pressure on themselves to find the “right” way to do something, she says. The truth is, clinicians can work with the same client in multiple ways and take different therapeutic directions and still arrive at a positive outcome, Henderson says.

Prioritize fostering growth. Might your supervisees end up working for a local competitor or leave your agency and move on once they’re licensed? Be supportive and invested in their growth, even if it won’t benefit you in the long run, Doyle urges. “Don’t think of [supervision] as just one more thing to get through. Don’t think of it as a task but as a relationship to foster,” he says.

One mark of a good supervision relationship is when a supervisor is comfortable enough to allow — or even to encourage — a supervisee to seek additional skills elsewhere, Simmons says. For example, if supervisees use different therapeutic modalities than their supervisors do, they might want to look for workshops or online training while
in supervision.

Help supervisees embrace their counselor identity. Supervisors can help prepare supervisees for work environments in which they may be the only counselor. “Once people get into a work environment, there becomes a lot of pressure to do things not in the way a counselor is trained to do. Part of a supervisor’s job is to train a supervisee not to lose their identity as a counselor,” Reiner says. “Sometimes you might get the message, ‘We know that’s what you learned in college, but that’s not how we do it.’ Be mindful of teaching them to be a team player yet [also] an advocate for counselors and counseling.”

For example, a counselor in a school setting may be the only person in the building with a counseling background, and he or she may repeatedly be asked to spend time as a test proctor or hall monitor or to perform other noncounseling duties. “How do you politely tell your principal that counselors are not lunch monitors?” Reiner asks. “Instead, explain that your approach will be different. ‘I will do it, but I’ll do it within my counselor identity. Instead of being a disciplinarian, I will use it as an opportunity to talk to students.’”

Lift supervisees up. Supervisees should leave the supervision experience even more energized about the counseling profession than when they began, Brown says. “The way I see it, our job is to lift them up. To help them see that they are more capable than they think they are. To teach, to offer guidance and education, and to model how we do what we do. … Yes, there are techniques and ethics and strategies, but there is also joy in the giving. Graduate students don’t often pick up on that part in grad school. I believe that is the key element we, as supervisors, need to be offering to new counselors. This will help keep integrity in the profession and prevent burnout [by] shining a light on the ability to truly offer healing to clients.”

Navigating the ups and downs

Because supervision is an experience that involves two human beings, it is only natural that not every experience will be positive. Frustration, awkwardness and other negative feelings may surface.

Conflict can arise easily in supervision relationships in which expectations are unclear, Henderson notes. To decrease the likelihood of that happening, she recommends that supervisors document their expectations thoroughly before supervision begins, regardless of whether that process is mandated by the state in which the supervisor practices.

Among the details that should be included:

  • How the supervisee will be evaluated
  • How often the supervisor plans to meet with the supervisee
  • The cancellation policy should a supervisee need to miss a meeting
  • The length of the supervision or how many hours are expected
  • How much the supervisee will pay the supervisor (if applicable)

These details should be talked through with supervisees before they agree to sign the document.

This is also a good time to map out wellness goals, says Doyle, who has supervisees include self-care in the learning contract they create at the beginning of supervision.

“In many ways, it’s on the supervisor to try and develop a welcoming, supportive, yet honest and challenging relationship with their supervisee,” Reiner says. “That starts out with being very direct and forward with your supervisee about what is expected and how they will be evaluated.”

The importance of being direct also extends to addressing any differences between supervisors and supervisees, from level of expertise to gender identity to spirituality, Reiner says. She recommends asking supervisees upfront, “How are you feeling about these elements of who you are and who I am and how that comes together in our space together?” In addition, she says, supervisors can offer assurances to ease supervisees’ concerns about those differences: “If there’s ever a time when I’m not hearing you or not understanding you, please tell me. I want to hear it because it will only help our relationship.”

When tough conversations arise or when things aren’t going well in supervision, it is helpful to keep the discussions focused on growth opportunities. In her role as a counselor educator, Reiner sometimes has to mediate meetings between supervisors and supervisees who aren’t seeing eye to eye. She begins by asking both, individually, what is going well, what can be improved on and what they would like to do or see in supervision that hasn’t happened yet. Reiner tries to frame the conversation so that both parties are able to take personal ownership of what has transpired without placing blame. That way, they are able to share and focus on what they want from the experience that they haven’t yet received.

Clear and open communication is essential when the supervision relationship is having its ups and downs, agrees Henderson, and that is when a supervisor’s counseling skills especially come into play. Supervisors should focus on concrete expectations that aren’t being met rather than vague or arbitrary attributes that they may not like, such as a supervisee’s personality or professional style. If necessary, supervisors can also refer to the contract put in writing at the beginning of the relationship, she adds.

“Many times, we talk around things without talking about the process that’s going on in the room, that here-and-now experience,” says Henderson, who presented on supervision and ethics at the ACA 2018 Conference & Expo in Atlanta. “Oftentimes we need to go to that level of metacommunication, to use counselor lingo, to address the dynamics that are happening between us and what’s contributing to it. That can be a very difficult conversation to have, especially considering the power differential. I like to make it as concrete as possible. Having clear expectations and a contract helps focus on competencies and what’s not being met.”

“[Sometimes] it’s these unexpected lessons that find us, that we’re not looking for, that can be the most difficult but that lead to the most growth,” she adds. “When we are having these conversations, keep in mind our mutual goals. What’s our purpose? The supervisee’s growth as well as client welfare. Monitor both.”

Keep it going

Peer support and feedback, mentorship and case review with colleagues can play a vital role throughout a counselor’s career, long after formal supervision leading up to licensure has ended. Doyle recommends that counselors engage in lifelong supervision, whether in an informal or formal capacity, to continue learning and to find support.

“It’s extremely rewarding work that we do, but it’s extremely taxing too. Peer support becomes that much more important after formal supervision ends,” he says. “It’s hard to describe the grind you go through daily as a counselor and the emotional toll it takes. Connect with people who can understand that. Connect with peers across the profession, whether that’s within a professional organization or the practitioner in the office next to you. Make sure you have a support network, wherever you are.”

Henderson says one of the things that stuck with her most from Irvin Yalom’s keynote at the ACA 2017 Conference & Expo in San Francisco was that he — a noted psychiatrist, author and scholar — had sought support from peer groups throughout his storied career. “Even though he’s a giant in the field, he continues to work on his own development,” she says.

“The message that we want to send is that the journey doesn’t end when you get that license or degree,” Henderson adds. “The journey is ongoing, and we don’t want to be alone in that journey.”

 

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Related reading: Counselor supervision: Reflections and lessons learned,” an online-exclusive companion piece to this article: wp.me/p2BxKN-58U

 

Additional resources:

From the Counseling Today archives:

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Behind closed doors

By Zachary David Bloom May 7, 2018

Few topics are more controversial or downright uncomfortable to talk about than sex and sexuality. It seems we could examine any period of time in human history and find a number of social values and ideas related to sexual behavior, all of which might be discussed with some nuanced language or slang of the time. More often than not, we would find some positive messages about sex but also a fair share of messages that promote — intentionally or not — feelings of guilt and shame. Even with the timeless double binds that accompany messages around sex and sexuality, it is important to recognize that sex remains an important part of our storied history. After all, without sex, we wouldn’t even be here to have this conversation.

When we talk about sex, we are talking about something loaded with assumptions and values. Sex does not exist in a vacuum; rather, it is woven into our personal identities. It is with that idea that I want to encourage sensitivity and tolerance for a topic that has been dressed up and dressed down: pornography.

Sex and pornography in the 21st century

When considering key markers of sex and sexuality that exemplify the zeitgeist of today’s technological era, one might think of pornography, an industry that pulls in billions of dollars each year. Access to pornography has only increased with widespread use of the internet and the diverse number of gadgets available to connect to it. As such, it makes sense that counselors report working with more and more clients who have issues related to their pornography use.

Researchers have attempted to establish correlations between pornography use and a number of other issues of clinical concern (e.g., depression, anxiety), but it has been difficult to draw any definitive conclusions. However, we do know that clients are presenting to counseling for issues in their romantic relationships related to pornography use (e.g., fighting about how much or how often it should be viewed, if at all), for issues that mirror symptoms of addiction related to their pornography use and for a variety of other issues that can be traced back to their pornography use.

Some of the more nuanced issues related to pornography use include clients reporting decreased sexual satisfaction in their primary relationship or even an inability to perform sexually because of a desensitization to sexual stimuli. Some clients report experiencing anxiety and distress about expectations — either self-imposed or solicited by a partner — to replicate acts depicted in pornography that contrast with the client’s value system. Similarly, some clients report experiencing distress connected to feelings of inadequacy that result from comparing themselves with the actors and actresses in the pornography industry.

This is not an exhaustive list, but I believe it speaks to what has been identified in the counseling literature and what counselors have anecdotally reported seeing in their practices, which parallels what I have seen in my own clinical practice. It is also worth noting that clients are more likely to come to counseling with presenting issues that appear not to connect to their pornography use. Most often, this is because the presenting issue simply has no connection to their pornography use. Other times, it is because clients have not yet gained awareness of how their presenting issue relates to their pornography use or, commonly, do not yet feel safe enough in the therapeutic relationship to talk about their pornography use. Yet the question remains: Why are clients now coming to counseling for issues related to pornography?

Accessing pornography

Imagine a child on a school playground in Anywhere, America, playing with their friends when they hear a sexual word or phrase that they’ve never heard before. Maybe they don’t even know that the word has anything to do with sex or sexuality. Now imagine that the child is too embarrassed to ask their friends about it, so the child either types the word into an internet browser on their smartphone or waits until they get home to Google it. In a matter of seconds, the child is confronted with definitions that might go beyond their scope of understanding or is seeing a sexual act, either via high-definition images or video.

Although this example doesn’t fit as well for older age groups, it is representative of how the cultural narrative around pornography has changed from previous decades. You can imagine that the same child in the 1970s or 1980s would not have had easy access to that kind of content. Instead, the child would have needed to ask a friend or relative to explain the concept or term. Even if this person felt uncomfortable with the question or was not the ideal person to ask, there still would have been a connection between the two people. In other words, the child would not have been left to wrestle with this concept in isolation.

In previous decades, if minors wanted to access pornography, they had to find it, borrow it or steal it. Adults needed to show an ID to purchase it. Today, the only thing required to access pornography is a technological device. Even devices with software blocking services work inconsistently at best. Consequently, we are simultaneously more connected and more isolated than we have ever been in human history.

When we think about the dynamic and contrasting messages that society promotes about sex and sexuality and place that in conjunction with sexuality being tied into a person’s identity and valuation of themselves and others, it makes sense that we are seeing an increase in problems related to client pornography use.

Discomfort with sexuality

One could make the argument that most clinical issues might increase or decrease along with the availability of and accessibility to: fill in the blank. For example, a couple might argue more when they reach retirement and spend more time together (i.e., an increase of minutes together). The issue of pornography, however, is more dynamic than its presence or absence because it is a piece of the larger puzzle of sexuality. As readers are likely aware, there is often a significant amount of shame and guilt tied to issues of sexuality — for clients and counselors alike.

Sexuality is described as being part of the human experience, and the helping professions’ various accrediting bodies recognize it as such. However, human sexuality is not a standard and mandated part of counselors’ training. In fact, the general sex education that a counselor receives as a child and adolescent in elementary, middle and high school varies in depth and breadth — if it’s covered at all. Consequently, counselors experience a wide spectrum of comfort levels when it comes to discussing issues of sexuality in general. In addition, counselors’ comfort with sexuality influences their propensity to assess and treat clients for sexual issues.

Perhaps because of their lack of formal or meaningful sex education, some people — including counselors — have reported turning to pornography to learn about sexuality. The concern about this is that pornography is not considered to be a realistic portrayal of sex or intimate relationships. Thus, it might lead individuals to form unrealistic expectations about what happens in a sexual encounter and to pursue sexual activities that could interfere with fostering a successful or satisfying sexual experience. At the same time, counselors might be impaired to provide helpful or accurate psychoeducation to their clients related to sexuality if they do not have a more reliable source of information than pornography.

Taking down barriers

The best way to position yourself to meet your clients’ needs when it comes to working with issues of sexuality or pornography is to know yourself. These are controversial topics, and the first step in being available to your clients is to take ownership of your own beliefs, values and attitudes about sex, sexuality and sexual behaviors. As a starting point, ask yourself how comfortable you feel when thinking about working with a client who reports wanting to reduce their pornography use or who says their pornography use is interfering with their romantic relationship. If you notice discomfort or an aversion to working with a client on those issues, it might be a good time to seek consultation or supervision concerning the source of your discomfort.

In my experience with counselors-in-training and counselors I have met at various conferences, the discomfort tends to stem from one of three things:

1) Religious or spiritual values that make it difficult to maintain a stance of unconditional positive regard

2) Previous experiences of trauma that make it difficult to stay present when delving into discussions of sexuality

3) Feelings of incompetence when it comes to forming or maintaining healthy sexual relationships

For issues of personal values and beliefs — whether stemming from religious/spiritual foundations or not — I think it can be beneficial to pursue counseling services to explore those feelings of discomfort. Counseling can be an effective way to question and deconstruct beliefs that might be interfering with the formation or maintenance of a therapeutic relationship with a client who is wrestling with any of these issues. I find it helpful to allow myself to maintain my belief system and simultaneously place brackets on that belief system so that I can join a client or couple without my lens impeding on their experience. Sometimes I find that working with a client or a couple might remind me of an old belief or value that I once held. I can recognize that the belief is no longer serving me and that I am ready to discard it.

As this discussion relates to previous experiences of trauma, we understand that healing is an ongoing process. Sometimes we might believe that we are healed until we are confronted by our own limitations. We then recognize that it is time to delve further into healing from the past so that we can stay in the present. This, of course, extends beyond issues related to sexuality; it applies anywhere in the counseling relationship in which we find ourselves bumping up against our own walls.

As it concerns feelings of incompetence, counselors’ training in treating issues of human sexuality and their general exposure to sex education vary. I suggest that counselors ask themselves three things: What do I know? What do I want to know? Do I feel confident to relay this information?

To address any deficit in knowledge or any identified room to grow or learn more, I recommend that counselors prepare themselves to work with clients by finding educational resources on sex and sexuality. I also encourage counselors to pursue additional training or workshops through their professional memberships and state and regional conferences. Through identifying our areas of discomfort and our learning curve for the future, we prepare ourselves to best meet the needs of our clients. Of course, we need to be aware throughout the entire process of what our limitations are and when it is time to refer out to another helping professional and possibly even to a certified sex therapist.

In addition to preparing ourselves for working with clients through their sexual issues or regarding their pornography use, we need to provide a space for clients to address these issues. Counselors who report working with clients for issues related to their sexuality or pornography use also often report that they did not ask their clients about these issues. I believe that by soliciting that information early in the counseling relationship — through an intake questionnaire or intake interview — we implicitly state to our clients, “I am willing to discuss this issue, and this is something you can talk about here.” Again, because of the amount of guilt and shame our clients can feel around issues of sexuality, it becomes that much more important to ensure that we are maintaining a safe, supportive and confidential professional relationship.

In my clinical practice, my intake questionnaire includes a space for clients to report on areas in which they have concerns (or in which a family member or friend has raised concerns about them). These areas include gaming, eating, gambling, shopping, sexual activity and pornography use. Only rarely do clients circle “yes” to sexual activity or pornography use. More fruitfully, however, when reviewing the intake packet with clients in session, I ask, “Would this be a place where you might feel comfortable enough to talk about any issues related to sexual activity or pornography use if it came up?” Even if clients state that they do not have a problem in those areas, by having that conversation early on, the implicit message I send is that they can address any concerns related to sexuality or pornography should they ever want or need to.

The work

Beyond knowing ourselves and our own limitations — including when to seek counseling ourselves and when to refer out — there are a handful of recommendations for working with clients regarding sexual issues or pornography use. First, it is necessary to co-create a working definition with the client regarding the presenting issue and any important terms being discussed. In the case of pornography, I recommend asking clients how they define what pornography is. Across the counseling literature, definitions of pornography vary, but what is most important is that you and your client are speaking the same language. So, from the client’s perspective, does something qualify as pornography only if explicit sexual acts are involved, or is it anything that includes nudity? Does sexually provocative material count, even if it does not include nudity?

It is necessary to create this shared definition so that you don’t accidentally dismiss a client’s use of “pornography” as not warranting attention when it is something that is causing the client distress. For example, if a client experiences feelings of guilt for viewing images of clothed people in sexually provocative positions, we want to validate the client’s experience of guilt, even if it might not intuitively resonate with the way that we personally define pornography.

In the same vein, we want to ensure we have a shared definition so that we do not miss opportunities to assist our clients in meeting their clinical goals. For example, I once worked with a man who wished to abstain from pornography use and masturbation for religious and spiritual reasons, and he seemed to be making progress. However, I came to realize that although he was abstaining from traditional pornography use and masturbation, he had begun to engage in more frequent promiscuous sexual behavior. After finding out more about his promiscuous behavior, we were better able to define the “spirit” of his counseling goal, which was to gain greater control over his sexual activity — including abstaining from anonymous sex.

Both in co-creating definitions of pornography with our clients and in the clinical work we do with them, it is also necessary that we model appropriate language. There are compelling reasons to believe that pornography use might promote sexist or harmful beliefs about women resulting from how they are portrayed in pornography. As social justice advocates, it is our job as counselors to balance the deconstruction of sexist or misogynistic ideas without alienating our clients by using overly clinical language or shaming them.

In practice, this means finding a way to ask clients to clarify what they mean when they use a certain term. Similarly, when we use a sexual term, we want to make sure we are using language that the client understands that is also as free of negative associations as possible. In my experience working with clients, depending on the length and strength of our therapeutic relationship, I will typically begin by using the client’s language — asking for clarification when I hear a new term with which I am unfamiliar — and gradually introducing more neutral language to replace the previously value-laden language. As I do this, sometimes the client will follow my lead and it becomes a trend that continues until we are using more value-neutral language throughout all of our sessions.

Other times, I might find a way to introduce a moment of psychoeducation in which I clarify my change in language with the client. I then ask the client to try changing their language too as an experiment to see if they notice any differences in the way they are thinking or feeling. Usually, I can find a way to do this that supports the presenting clinical concern. For example, with a client who presents for counseling for symptoms of depression resulting from the termination of a romantic relationship, I might be able to make a connection between “power” in a relationship and the importance of “respect” in a relationship. We can then discuss how altering our language is a concrete step we can take toward facilitating the change of finding more respect and more even distributions of power in a relationship.

Beyond taking general steps to prepare yourself for working with issues related to sexuality and pornography use, it is also important to be able to provide specific psychoeducation to clients regarding their presenting issue. This is not something that is achieved and completed but rather an ongoing component of being a counselor. Sexuality is diverse, and we need to have sound sources of information not only for ourselves but also for our clients.

Typically, I find in my work that a client’s presenting issue includes myths or deficits in knowledge about sex and sexuality. With younger clients, I find that the deficit in knowledge is often related to safe sex practices. Therefore, I recommend familiarizing yourself with books that you can feel comfortable promoting and sharing with your clients, and internet videos or links that are not pornographic in nature that can serve as educational resources.

Individuals and couples I have seen in counseling for issues related to sexuality or pornography use tend to have one thing in common: They want to have a fulfilling sex life. Consistent with findings in the counseling literature, I emphasize to my clients that a fulfilling sex life comes from a sexual relationship that is founded on trust and vulnerability. In line with that, for some individuals and for some couples, pornography use can be a barrier toward open, honest and vulnerable sexual expression, especially when their sexuality is framed by messages of expectation. Instead, I promote mindfulness practices, sensate focus activities and building on previous experiences of success. Overall, I find that clients make the most progress when they understand that the sexual fulfillment they are seeking is with their actual partner and not with an imagined conceptualization of their partner or a different and more ideal partner.

As part of counselors’ work of addressing issues of sexuality and pornography use, we need to be prepared for clients to ask us about our own sexual experiences and whether we use pornography. I don’t know how often clients actually raise questions along those lines, but I think that we need to be prepared for such instances. As with most topics, I encourage counselors to explore their own levels of comfort with disclosure and to assess whether their disclosure is for their clients or for themselves. Some disclosures are more or less appropriate with certain clients but not others. However, the entire topic of disclosure becomes especially complicated and potentially harmful when discussing sexuality and pornography. Because of the sensitive nature of the topic, I would encourage you to err on the side of caution when making any disclosures with clients about your own experiences, and I would also encourage you to be prepared with a statement so that you are not caught off guard by a client’s questions.

In the classroom, in session and at various counseling conferences, I have been asked about my personal stance on pornography use. The response that resonates most for me is to remind my clients that what might be right or wrong for me might not be right or wrong for them. In addition, I would not want to influence their choice or decision beyond assisting them in identifying their beliefs about sexuality and helping them to live congruently within their value system.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Zachary David Bloom is an assistant professor at Northeastern Illinois University. He is also a licensed clinical professional counselor and a licensed marriage and family therapist. He specializes in working with couples and with individual clients with trauma. His research interests include the influence of technology on romantic relationships. Contact him at zacharydbloom@gmail.com.

Letters to the editorct@counseling.org

 

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Related reading, from the Counseling Today archives: “Entering the danger zone

The absence of formal and accurate sexual education is a particularly American problem that may find its way into the offices of professional counselors. wp.me/p2BxKN-3JE

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The relationship as client

By Laurie Meyers September 22, 2016

Among the most common difficulties that bring couples to counseling are infidelity, financial problems, sex and intimacy issues, parenting challenges and ongoing tensions with the in-laws. Each of these problems has its own unique characteristics, but according to couples counselors, they tend to share a similar root cause — namely, lack of communication. The challenge for couples counselors (and their clients) is to identify how communication went awry — or if it ever truly existed in the first place — and then work to reestablish it.

Couples counseling is fundamentally different from individual counseling, says Paul Peluso, past president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

“Too often, counselors think that couples counseling is ‘individual counseling times two,’ and they conduct individual counseling with each person, while the other partner observes,” Peluso says. “That really isn’t couples counseling. Instead, with couples counseling, you have not just branding-images_inkhearttwo perspectives in the room that you have to balance, but you have the … relationship that you are working with. In fact, it is the couple’s relationship that technically is your client, not the individuals in the couple.”

Having a relationship as the client instead of an individual makes it much more challenging to build a therapeutic alliance, says Barbara Mahaffey, a licensed professional clinical counselor and ACA member who practices in Chillicothe, Ohio. The relationship is not just an entity, but rather two separate people who have different thresholds for opening up and trusting, she explains. Couples also come in with different goals and expectations. Mahaffey, who specializes in counseling couples and families, says her task as a counselor is not just to address these goals and expectations, but to help the couple discover how they can reconcile their personal expectations and establish new goals that will allow them to move forward as partners.

“Couples will come in and want to fight over who is right and who is wrong in the relationship,” Peluso says. “It is the couples therapist who has to sell the idea that no one is wholly ‘right’ or wholly ‘wrong.’ Paradoxically, neither is to blame and both are to blame — in the technical sense — for the state of the relationship at the same time. Both have played a role in setting up the conditions for the relationship. So the focus is on how each person’s behavior and reactions to [the] other affect the couple’s relationship. If each person wants to be in the relationship, then they have to take responsibility for how their behavior impacts the health of the relationship. And this is very different than individual counseling.”

Confronting infidelity

Unfortunately, the catalyst that most often pushes couples into a counselor’s office is also one of the most difficult issues to move past.

“The single most common issue that brings couples into therapy is infidelity,” says Peluso, a licensed marriage and family therapist (LMFT) who has written several books about both infidelity and couples counseling. “Over the last 20 years, researchers have demonstrated that this is the most common presenting concern, and if it is not revealed initially, it is often disclosed in the course of couples therapy. Infidelity can take many forms, from sexual to nonphysical intimacy, and it now includes relationships online.”

“In terms of who cheats, researchers have found that women are just as likely as men to participate in infidelity,” Peluso continues. “As a result, practitioners have to know how to deal with the complex and often devastating issues that accompany infidelity. Unfortunately, when couples counselors are asked about it, they overwhelmingly say that it is the topic they feel least prepared to treat.”

Amber Lange, a licensed professional counselor who owns and practices at Bedford Health, a group practice in Lambertville, Michigan, can attest to the high demand for infidelity counseling. Her practice has become known for specializing in issues surrounding infidelity and betrayal. Initially, the sheer need for counselors knowledgeable about and willing to tackle this particular relationship threat astounded her. “I’ll never be out of a job [as an infidelity specialist],” she says ruefully.

Among couples for whom the act of infidelity is fresh, the nonoffending partner is typically experiencing acute stress and may even have symptoms that resemble posttraumatic stress disorder, Lange says. The offending partner, on the other hand, is typically feeling beaten down because he or she has repeatedly been asked blunt questions that shine a direct light on his or her indiscretions: What did you do? Where? How much money did you spend?

In cases in which the infidelity is years in the past, the core counseling issue more often involves a lingering lack of trust, Lange says. “The nonoffending partner [may have] forgiven the offending partner, but they have never rebuilt trust,” she explains. “So the nonoffending partner is hypervigilant about trust and the [possibility of the] offending partner reoffending.”

If the act of infidelity is recent, Lange helps the couple work through their “why, who, where, how” stage. “I talk about the idea of how you can’t ‘unknow’ something once you know it,” says Lange, a professor of counseling at Capella University. “There’s a lot of knowledge that you can gain that may further traumatize you, such as the sexual positions that your partner was in with someone else.”

Clients may also wonder if their partner did things with another person that the nonoffending partner refused to do. If this information is disclosed, Lange explains, it can lead the nonoffending partner to do things he or she is uncomfortable with in an attempt to please the offending partner.

Instead of attempting to get answers to questions that can further damage the relationship, Lange encourages the nonoffending partner to ask structured questions such as: When did you start having sex? When did you stop? Did you have unprotected sex? These types of questions provide information that the nonoffending partner needs to know, Lange says.

The next phase of Lange’s therapeutic approach involves narrative therapy. As part of this stage, Lange might ask couples who delayed getting therapy after the infidelity to briefly touch on information about the affair as a way to see if there are lingering questions. This process also helps Lange to assess the strength of the couple’s bond.

The story of ‘us’

Regardless of whether the couple is confronting a recent infidelity or the infidelity happened years in the past, constructing the story of their relationship represents the core of the healing process, according to Lange. Couples build the narrative to gain a clearer understanding of how and when the cracks in their relationship developed, she explains. They talk about the beginning of their relationship and explore how they interacted. Were they friends and true partners? What happened that started pulling them apart?

“Life” — deaths, births, work, money and so on — is usually the answer to that second question, Lange says. In addition, people typically change over time, which further alters the nature of the relationship, she notes. All of these factors in combination can make a relationship vulnerable to disruption. Add in misperceptions and unmet expectations, and once tiny relationship fissures can turn into large cracks that cause couples to drift apart.

Among the most common life events that can start to pull some relationships apart is the birth of a child, Lange says. “Before the birth, couples were able to spend all their time and energy and money on each other. After the birth of a child, ideally, you love that child and invest all of that [time, energy and money] in parenting and child rearing — which is not bad, but [couples] come into my office, and they haven’t been on a date in three years.”

In addition to not making time for the romantic relationship, the couple may be trapped in patterns that are actively pulling them apart, Lange says. “You’ve been great parents, but the mother is staying home or working and raising kids at the same time, the father is working and overworking to pay for the mortgage and save for retirement — those kinds of things can hurt a relationship,” she says.

When a couple stops talking to each other, it creates a gap, and it is tempting to fill that gap with other people or activities, Lange notes. Partners may begin to betray each other in different ways, whether it is spending time on social media instead of with each other, watching pornography or working long hours, she says. “In the process, we’ve let the relationship go awry,” Lange observes.

But this risk of unraveling is not exclusive to couples with children. Those who get married or enter into domestic partnerships too quickly upon meeting or when they are very young are also particularly vulnerable, Lange says. For example, those who form romantic relationships in their teens or early 20s are in the midst of experiencing significant personal development. This may not happen at the same rate for both partners, eventually leaving them feeling as if they don’t know each other, Lange explains. Likewise, people who get married or form a domestic partnership in the matter of a few weeks have not typically had enough time to establish a strong base of friendship. Over time, it’s not uncommon for them to realize that they don’t even like each other, Lange says.

Lange asks clients not to make a decision about whether to stay together until after they have gone through the process of identifying what went wrong. Then, if they choose to stay together, Lange helps them start to discuss how to protect the relationship going forward. This typically includes setting aside time to talk with each other more frequently, being intentional about making time for dates and even going on vacations without the kids. But it also involves each partner identifying the behaviors in which he or she engages that play a role in pulling the relationship apart.

For example, Lange recounts something that a client recently shared. “One of the things that I have recognized about myself over the past six months is that I tend to withdraw,” the client told her. “When my partner and I got into an argument, I went away, slept in the kids’ room and wouldn’t talk. I would work 85 hours a week. Even when I wasn’t in the office, I was checking my email.”

In essence, Lange says, the client just wasn’t “there” in the relationship. Other people do the same thing by burying themselves in hobbies such as sports or scrapbooking. As a result, they end up spending more time with friends or with hobbies than they do with their partner and family, Lange says.

The process of building the couple’s story in counseling and finding the cracks and vulnerabilities is a long one. For the first four to six weeks, when a couple is still going through the initial trauma phase of the infidelity, Lange has them come to counseling every week. Once a couple moves on to the storytelling stage, she has them come to counseling only about once per month, in part because she feels that much of the processing and healing needs to take place between sessions as the couple slowly rebuilds the relationship.

“They have to have time to figure out things … how to be in relationship, how to recreate their friendship and how to build [new] good memories,” Lange says. During the process of rebuilding the relationship, trust is also being reestablished and forgiveness is being granted. Then the couple can move forward, she explains.

Ideally, the couple will also identify potential problem areas and reach compromises on how to address those issues. For example: “You say I can’t work 90 hours a week, but we need money, so how are we going to figure that out? … This is [our] story. Here’s the way we go forward. Here’s what we need to do.”

Symptom vs. problem

Brian Canfield, a past president of ACA, also says that infidelity is the event that most commonly brings couples into his office. But he believes infidelity is always indicative of other underlying problems in the marriage or relationship.

“I view an affair not as the problem but as a symptom,” he says. “An affair is like malarial fever. It’s uncomfortable, but it’s not the fever itself that’s going to kill you — it’s the disease.”

Canfield believes that if a counselor addresses the underlying issue first, it will help to stabilize the couple, which will then allow them to deal with the ramifications of the infidelity. “You [the counselor] have to assess if there is a commitment and desire to save the relationship,” says Canfield, an LMFT whose practice has offices in Louisiana, Arkansas and Florida. “Trust and betrayal, that’s not where you put the spotlight. The trust will return once you stabilize the relationship.”

Canfield starts by asking the couple what they want out of the counseling process and their relationship as a whole. “What would you like to see happen? If it is possible to salvage the marriage, would you be willing?” Canfield asks. “A lot of people want to know why [the affair happened], but here is where we are. Where do you want to be? If you were going to redesign marriage, how would it look?”

Canfield says financial difficulties are the most common underlying issue that couples bring into his office. In his experience, there is so much shame surrounding finances that most couples would rather talk about the details of their sex lives than money. He frequently encounters situations with couples in which one partner has been maintaining a hidden bank account or run up the balance on their credit cards without the other partner knowing. He tells couples that part of the counseling process involves full disclosure.

“A lot of couples are in tremendous denial,” Canfield says. “They don’t know how much debt they are in, what their bills are or have a good picture of how much income they are bringing in.”

Sometimes people feel entitled or convince themselves that it’s OK to buy what they want regardless of how it affects their spouse or partner. They tell themselves that they work hard and that they deserve it. Canfield sees part of his role as helping to bring clarity to these situations to encourage better choices.

“The other spouse may say that if this doesn’t change, I will exit the marriage for my own survival. Which circumstances are more important? Keeping the marriage or continuing to spend?” he asks.

Canfield doesn’t try to play the part of financial adviser to couples (although he does recommend that couples seek professional financial advice elsewhere if needed). Instead, he helps couples recognize their need to possess a clear picture of their financial situation and to develop a reasonable budget.

“It’s a matter of priorities and trade-offs,” he says. “The key as a couples counselor is to have the couple work together as a team. Most couples, when they work as a team, can find common ground.”

Canfield emphasizes that as a couples counselor, it’s not up to him to dictate how much a couple will spend on their priorities. Instead, his focus is simply on making sure that they have agreed on a plan going forward.

Once the underlying issues have been addressed, Canfield helps the couple deal with what he calls the “moral disparity” in a relationship in which infidelity has occurred. The nonoffending partner may feel like he or she has the higher moral ground, but to move forward, the couple must try to reach a “mutual amnesty,” Canfield says.

This involves a delicate balance. Canfield tries to make the couple aware that the infidelity occurred because of the underlying problems — to which they both contributed — that were straining the relationship. However, he always makes it clear that it is not the fault of the nonoffending partner that the other partner cheated. Yes, they both contributed to the relationship’s problems, but the offending partner chose to act out by having an affair.

Matters of miscommunication

Mahaffey, an associate professor of human services technology at Ohio University–Chillicothe, finds that relationship difficulties usually involve a significant degree of miscommunication, which is exacerbated by a number of factors. She helps couples understand how communication can get mixed up by explaining the pieces of a “miscommunication model” that she has devised.

Mahaffey starts by asking both partners to list all of the traits they possess that are different from their partner’s traits. She then takes these lists and draws two people facing each other. This represents two people talking, whereas the lists represent their different — and sometimes conflicting — points of view. Mahaffey often also draws a “family rule book” between the two figures. This represents how a person’s family of origin can affect the way he or she interprets interactions with a partner. Mahaffey often asks couples about their family backgrounds and experiences to illustrate the influence of the family of origin.

Mahaffey will then ask both partners to think about all the times they asked for something and didn’t receive what they wanted from their partner. As they voice these details, it’s not unusual for one partner to exclaim, “You never said that!” Typically, the case is not that either partner is lying, Mahaffey says. Rather, it’s that one of the partners has not been phrasing the requests in a way that effectively communicates what he or she needs, Mahaffey explains. She also informs the couple that humans think at about 500 words per minute but cannot speak more than 125 words per minute, meaning there is ample opportunity for the intended message to get lost.

Other complicating factors in communication include different coping styles (such as one member of the couple shutting down verbally or retreating physically or emotionally during times of stress), the fact that women often process information differently than men and the daily anxieties of life, Mahaffey says. For example, it’s hard for a couple to communicate effectively when one or both partners are stressed about finances, work or the car breaking down.

The last part of Mahaffey’s model entails explaining how words themselves — or how people define them — can get in the way. For example, Mahaffey might ask a couple, “What’s the definition of love? Is it that supper is on the table when I come home? Or liking to snuggle? Or texting 60 times a day?”

At this point, Mahaffey has the couple use “I” statements and talk about what needs they feel are being unmet. One partner might say, “I like to have help with housework.” The other partner might note that the request usually comes during a football game or while engaged in something else that he or she enjoys doing. At this point, Mahaffey might ask if the partner would be willing to provide help either before or after the game. This exercise highlights just one example of an area of possible compromise. The larger point is that the couple needs to sit down and talk about what they need from each other and how those needs can be met, Mahaffey says.

Intimate partner violence 

All counselors, but couples counselors in particular, should be looking for signs of intimate partner violence (IPV) among their clients, asserts Ryan Carlson, an ACA member and couples counselor who has done research on screening methods for IPV.

Because IPV is such a prevalent societal problem, all counselors — knowingly or unknowingly — will encounter clients who have experienced or are currently experiencing violence at the hands of their partners, Carlson says. According to data gathered in 2011 and published in 2014 by the Centers for Disease Control and Prevention, more than 1 in 4 women and more than 1 in 10 men in the United States have in their lifetime experienced sexual violence, physical violence or stalking by an intimate partner.

Providing counseling in the presence of such interpersonal violence can be dangerous, not just to the victim but also to the counselor, says Carlson, a licensed mental health counselor practicing in Columbia, South Carolina. That is a primary reason it is important for counselors to be alert to the signs of IPV and to have a protocol to follow should a client be a victim.

Perhaps the most beneficial thing counselors can do is to get connected to the people Carlson calls the “real experts” on this issue — those who work at local domestic violence shelters. “Most of what I have learned [about IPV] has come from domestic violence advocates,” he acknowledges.

Not only can these advocates help counselors assess whether it is safe to work with a couple in which IPV is a reality, but they also stand ready to assist clients who are looking for help, says Carlson, an assistant professor of counselor education at the University of South Carolina.

Carlson says he uses the term IPV because it is more inclusive than domestic violence. There is an IPV continuum, and domestic violence is on the extreme end of the spectrum, representing the most severe cases that involve, as Carlson puts it, “power and control,” as opposed to nonlethal violence or verbal abuse. From Carlson’s perspective, it is not safe to try to conduct counseling in those cases involving power and control.

Carlson advises counselors to use a formal screening tool for IPV at intake but says there are other red flags to look for, including a client’s unwillingness to take responsibility for actions. “Control over finances or transportation is [also a] red flag,” he continues. “Is one partner restricting access to cell phones, finances, the car, who the other partner can interact with? … Look for body language. Does one partner consistently look to the other when they answer questions? Is it permission seeking? Is there inconsistency in their answers? For example, as part of a meeting to determine whether or not a couple would want to participate in a research study I was doing, I asked about income. The husband gave me an answer, but when I met with the wife separately, she said the husband wasn’t really working and that she wasn’t allowed to talk about that.”

This one disparity turned out to be an indication of severe domestic violence. Carlson followed his protocol and was able to get help for the victim.

What does a protocol look like? Carlson says he has a formal memorandum of understanding with the local domestic violence shelter saying he can call at certain hours when he has a need for consultation. The memorandum also states that he will not provide identifying information about the client, only basic relevant information. This includes the presenting problem and any context he feels is important. The consultant can then advise him on whether the couple’s case might be a power-and-control situation. In those instances, Carlson must find a way to offer help to the victim without tipping off the partner who is engaging in the abuse.

With all of the couples Carlson counsels, his regular practice is to meet briefly with each individual separately at the beginning of each session. This is primarily so that he can get each partner’s point of view independently on the difficulties the couple is experiencing, but it also provides him with a chance to provide contact information for the domestic violence shelter if circumstances warrant. Carlson and the partner who is the target of the abuse may even call the shelter together.

In some cases, however, the victim of the abuse is not ready to leave the relationship. Carlson say many counselors may have a hard time relating to that. “We think we need to get the person out of the relationship immediately, but [we] need to do it safely,” he cautions

The victim has typically been living under abusive circumstances for years and may not yet have reached a crisis point, Carlson explains. Again, he uses consultation with his domestic violence resources to help him navigate this terrain. Regardless of whether the victim is ready to leave, Carlson says the average counselor should not try to continue providing services in these power-and-control cases. Telling the couple that he feels this particular modality will not work for them has proved to be a successful way of terminating treatment without escalating the problem of abuse, he says.

Lynn Linde, senior director of the ACA Center for Counseling Practice, Policy and Research, adds the caveat that counselors should make sure their states do not require them to report suspected cases of IPV under mandated reporting laws.

There are IPV cases for which Carlson thinks couples counselors are qualified to help. These involve lower lethality or “situational couple violence” (as opposed to one partner begin generally aggressive outside of the relationship as well). In such instances, a couple’s arguments may get out of hand and they may engage in behaviors such as pushing or throwing things at each other. “This can be dangerous, but it’s not as dangerous as choking or using a weapon,” Carlson says. However, he says, it is important for the couple to acknowledge that this behavior is unhealthy and to show a willingness to learn more appropriate ways to interact. It’s also essential that neither partner is afraid of the other, Carlson stresses.

In contrast, partners who engage in power-and-control tactics usually show little or no remorse and may exhibit antisocial-type behavior, Carlson explains. In fact, he says, studies have shown that when engaging in the abuse, these types of offenders typically experience a drop in heart rate rather than an escalating heart rate that is typically associated with anxiety over one’s situation or actions. Carlson also notes that whereas research indicates that men are almost always the perpetrators of power-and-control types of IPV, situational IPV is gender neutral.

None of this information constitutes a foolproof method for deciding whether it is safe for a counselor to work with a couple with a history of IPV. That’s why Carlson continues to do research on screening methods that are better at identifying the presence of violence among couples and where on the spectrum of severity that violence falls.

“Getting it wrong can be very dangerous,” Carlson concludes.

Counseling LGBTQ couples

Although the issues that bring lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) couples into counseling are generally the same as those that affect heterosexual couples, the legalization of same-sex marriage has raised some issues unique to LGBTQ relationships, say counselors who work with this population.

“There is a tremendous validation both from the legal system and from society upon their relationships,” says John T. Super, an LMFT who is also a clinical assistant professor of counselor education at the University of Florida. “This validation can provide an emotional confidence or boost surrounding a same-sex relationship that lessens the perceived stigmatization that has occurred. Additionally, since the Supreme Court decision [legalizing same-sex marriage], we have seen a large number of those in long-term relationships choosing to marry and report feeling equality to traditional marriages.”

Although the Supreme Court’s decision is a huge advancement for the LGBTQ community and has given many couples the opportunity for which they have long waited, actually getting married has not been absent of negative consequences for some couples, says Super, a member of ACA. “Clients have explained [that] when they announced their marriage … it was in many ways similar to the coming-out process in that those who are choosing to marry and are in same-sex relationships may face resistance from friends and family as they legalize the relationship,” he explains. “I have heard clients say that their friends and family accepted their relationship, but when they choose to marry, the thought of the same-sex couple entering into a legal marriage is a line the friends or family are not comfortable crossing.”

Counselors have an important role in helping same-sex couples navigate the resistance they may face when they decide to get married, agrees Joy Whitman, a past president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. Amidst the joy of getting married, there may be feelings of hurt and loss from being rejected all over again by certain individuals or segments of society, she says. Counselors can help couples grieve and process this loss.

According to Whitman, who previously worked as a couples counselor, marriage can also exacerbate a common problem in same-sex relationships: unequal comfort levels with being “out.” Marriage can make the partner who is less “out” feel especially vulnerable, she explains.

Counselors should also be aware that for the first time, LGBTQ couples are facing divorce, Whitman says. Not only is this a new experience, but the need in many cases to stand up in court and disclose intimate relationship details can be particularly disconcerting for clients in same-sex relationships, she says.

Super and Whitman also note that counselors need to be aware of the generation gap among different LGBTQ couples. “Couples who are in their 20s experienced a very different level of social acceptance than couples in their 50s or older,” Super points out. “This generational difference can be important to understand when determining the levels of internalized oppression the individual or couple has experienced.”

Despite these issues and other issues that are specific to the LGBTQ community, Super and Whitman emphasize that couples counseling is couples counseling. Peluso, an associate professor of counselor education at Florida Atlantic University, agrees.

“In many respects, the practice of couples counseling shouldn’t change that much,” he says. “Focusing on the relationship means taking the relationship as it is created by the partners involved. The only judgment that the couples counselor is making is, ‘Is this healthy for you right now?’ and then seeing how the couple can change that. That is fairly universal.”

 

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Additional resources

To learn more about the topics addressed in this article, see the following select resources offered by the American Counseling Association.

 

Books (counseling.org/bookstore)

Podcasts (counseling.org/continuing-education/podcasts)

  • “Love and Sex and Relationships” with Erica Goodstone

Webinars (counseling.org/continuing-education/webinars)

  • “Crazy Love: Dealing With Your Partner’s Problem Personality” with W. Brad Johnson
  • “The Secrets to Surviving Infidelity” with Scott Halzman

VISTAS Online articles (counseling.org/continuing-education/vistas)

  • “Five Counseling Techniques for Increasing Attachment, Intimacy and Sexual Functioning in Couples” by Elisabeth D. Bennett, Jaleh Davari, Jeanette Perales, Annette Perales, Brock Sumner, Gurpreet Gill & Tin Weng Mak
  • “Helping Couples Reconnect: Developing Relational Competencies and Expanding Worldviews Using the Enneagram Personality Typology” by Thelma Duffey & Shane Haberstroh
  • “Loving Kindness Meditation and Couples Therapy: Healing After an Infidelity” by Laura Cunningham & Yuleisy Cardoso
  • “Supporting Same-Sex Couples in the Decision to Start a Family” by Debbie C. Sturm, Erika Metzler Sawin & Anne L. Metz
  • “Working With Intercultural Couples and Families: Exploring Cultural Dissonance to Identify Transformative Opportunities” by Cheryl L. Crippen
  • “Working With Sexual Addictions in Couples Therapy” by Sara L. Wood

Practice Briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling Couples With a Trauma History” by Catherine J. Brack & Greg Brack

ACA Divisions

  • The International Association of Marriage and Family Counselors helps develop healthy family systems through prevention, education and therapy (see iamfconline.org).
  • The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling seeks to promote greater awareness and understanding of LGBT issues and improve standards and delivery of counseling services provided to LGBT clients and communities (see algbtic.org).

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.